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CEREBRAL ANEURYSMS

Ruptured Aneurysms

Ruptured aneurysms are a whole different kettle of fish.  Approximately 10 in 10,000 people suffer aneurysm rupture every year⁶, though population based incidence rates range from 6-16 per 100,000¹⁹. Rupture rates peak between the ages of 55-60, though 20% occur in the 15-45 age range¹.  30% rupture during sleep, and about half of patients experience warning signs between 1-3 weeks before subarachnoid hemorrhage¹.  Some evidence suggests a higher rupture rate in the fall and spring¹.  10-15% of patients die prior to arrival at the hospital¹.  Mortality of those reaching medical attention can range from 40-50% within a month of rupture⁶.   Untreated ruptured aneurysms have a 15-20% risk of rebleeding in the first two weeks following the initial rupture¹, a 50% risk in the first 6 months¹, and said rebleeding carries with it an 85% mortality rate².  Approximately 30% of patients with ruptured aneurysms suffer moderate to severe neurological deficit, and about 66% of clipped patients do not return to their pre-SAH neurological baseline¹.

Sequelae of aneurysm rupture include subarachnoid hemorrhage (SAH), with attendant intracerebral hemorrhage (ICH) in 20-40% of cases, and/or intraventricular hemorrhage (IVH) in 13-28% of cases¹.  SAH may also lead to hydrocephalus and coma, subhyaloid hemorrhage (preretinal hemorrhage), intraretinal hemorrhage, or hemorrhage into the vitreous¹.  The most serious complication associated with aneurysm rupture is cerebral vasospasm, which can result in stroke, coma and death¹.  Vasospasm must be aggressively treated with “triple H therapy”: hypertension, hypervolumia, and hemodilution¹.

Using the recent New England Journal findings as our guide, we can conclude that approximately 3-6 million Americans have detectable cerebral aneurysms on imaging.  Other estimates put the number as high as 15 million⁵.  Given the risk of serious neurological deficit or death following aneurysmal rupture, elucidating screening protocols, identifying at risk populations, and instituting preventive measures and educational campaigns seem to be a reasonable undertakings.   

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